Background: Relapse after an initial response to infliximab therapy poses a problem for maintenance treatment. Aim: To assess the effects of increasing the infliximab dosage in Crohn s disease (CD) patients who initially responded but flared during maintenance therapy. Methods: This was an observational study. Twelve CD patients with both inflammatory and fistulizing manifestations were included. All patients initially responded to 5 mg/kg of infliximab, relapsed during maintenance therapy, and were treated with 10 mg/kg. The Harvey- Bradshaw index, the fistula activity, and steroid use were assessed before and after treatment with the increased dose of infliximab. Results: The mean Harvey- Bradshaw index score after flare- up during treatment with 5 mg/kg of infliximab was 13.5 ± 3.7. Treatment with 10 mg/kg, in a mean of 3.3 infusions, decreased the activity score to a mean of 8.8 ± 2.5. Two patients were weaned off prednisone, and a reduced dose was possible in the other steroid- treated patients. Conclusions: Increasing the infliximab dose may be beneficial in CD patients who initially responded to therapy, but relapsed during maintenance with the lower dosage.
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